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25 Cards in this Set
- Front
- Back
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Def'n Arthritis
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Joint swelling / effusion OR
2 of: tenderness or pain on movement limited movement increased warmth |
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What are the criteria for JIA?
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Onset < 16 years
Duration > 6 weeks Exclusion! No test |
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What are some exclusions for Dx of JIA?
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Infectious, malignant, pain syndrome, trauma, autoimmune, etc
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What are some cardinal features of joint infection?
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- Fever
- pain and tenderness - swelling - redness |
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What is the definitive Dx of joint infection?
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Aspirate and culture. Blood culture.
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Why is it important not to Dx TB monoarthritis as JIA?
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Because steroid tx will make it much worse.
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What is erythema migrans? Where (geographically) are you likely to get it?
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The rash associated with Lyme Disease. Northeastern United States.
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A 16 year old presents with polyarthritis in hands and feet and a bright red facial rash. Dx?
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Parvovirus arthritis
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An 8 year old developed arthritis 2 weeks after a sore throat and fever. Dx?
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Acute Rheumatic Fever secondary to strep A infection.
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How long after infection does reactive arthritis usually present? What is a common cause of RA besides strep? What will culture of joint fluid show?
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1- 3 weeks.
Enterics (salmonella) or viral. Culture will show nothing: joint fluid is not infected in RA |
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What are some clues that an arthritis may be due to malignancy?
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Fever, weight loss
Pain > findings Night pain HSM Anemia Metaphyseal lucencies on XR |
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What do metaphyseal lucencies specifically suggest?
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Leukemia / lymphoma
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When should you use steroids to treat arthritis?
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When the Dx is known. Don't want to give for infectious / neoplastic causes.
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What are some common causes of Hip Pain in childhood?
Age 2-6 4-10 10-14 |
2-6: transient synovitis following viral infection
5-10: Legg-Perthe's AVN of hip (cause unknown) 10-14: SCFE |
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In what group is SCFE often seen?
What is a sign of SCFE? |
Older, obese boys
When asked to flex hip, will get flexion + external rotation |
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What group are 'growing pains' seen? Why is the name a misnomer?
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3-10 years. Pain in calf, thigh, shins. No relation to growth.
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What are 5 Subtypes of JIA
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1. Systemic w/ fever and rash
2. Oligoarticular: <4 joints 3. Polyarticular (5 or greater) --> RF+ (rare!) or RF-ve 4. Enthesitis related arthritis 5. Psoriatic arthritis |
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What are some extraarticular findings on P/E and lab?
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Fever, rash, HSM, lymphadenopathy
Serositis Anemia ESR, CRP, WBC, PLTs, IL6 all high |
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Why is growth inhibited in long time sufferers of JIA?
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IL 6 suppresses growth
Steroid tx suppresses growth |
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What is the profile of a typical Oligarticular JIA sufferer?
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F
<5 more common than other forms ANA +ve RF neg flexion contracture and leg length discrepancy |
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Why should one examine the eye of someone with JIA, particular oligoarticular JIA?
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Uveitis. Often asymptomatic but can lead to blindness.
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Who is likely to get true RF +ve polyarticular JIA?
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Older girls. Still very rare.
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What is enthesitis related arthritis? Who is it more common in?
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Related to tendon-bone attachments. Seen way more often in boys > 8 than girls. HLAB27 +ve. Uveitis often symptomatic.
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All of the following are complications of oligoarticular JIA affecting the right knee except:
a) right thigh wasting b). overgrowth of right leg vs left c) right knee flexion contracture d) an irregular shaped pupil e) subluxation of patella |
E
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Management: JIA
1st line 2nd Line 3rd Line |
1st line: NSAIDS + / - steroid injections
2nd line: methotrexate / sulfasalazine 3rd line: TNF antagonist (Etanercept, Infliximab) |
